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URGENT CAR CENTE
WALK-IN M EDICAL C LINIC
5
il 11)
11. ALL INFORMATION MUST BE COMPLETED; PERMIT CAN BE DENIED DUE TO LACK OF INFORMATION. ,
12. This column to be filled in by
the Building Department.
Existing Proposed Required by
Zoning
Lot Size
Frontage
Front: 2,0
Setbacks:
Side: t
L: R: L: I U R: N 13
Rear: N
Building Height
Bldg Square
Footage
% Open Space:
(Lot area minus bldg and
Paved parking)
# of Parking Spaces
# of Loading Docks
Fill: (volume & location)
13. Certification: I hereby certify that the information contained herein is true and accurate to the best
of my knowledge.
DATE: I I� I ti APPLICANT'S SIGNATURE
NOTE: Issuance of a zoning permit does not relieve an applicant's burden to comply with all zoning
Requirements and obtain all required permits from the Board of Health, Conservation Commission,
Department of Public Works and other applicable permit granting authorities.
FILE #
Page 3of3
THIS FORM IS PART OF THE SIGN PERMIT APPLICATION
File No.
ZONING PERMIT APPLICATION
PLEASE TYPE OR PRINT ALL INFORMATION
1. Name of Applicant:
Address: 03,0'L Sj ' IJC r r ;vim Telephone: k S' ' L / 5 � 1
2. Owner of Property: 6l�CotLL
Address: to m _ g4 Telephone: (1/ 3 ' s/ 7LI
3. Status of Applicant: Owner Contract Purchaser Lessee
.Other(explain): // S 1 C3^-t ?A
4. Job Location: ( c 4 - y^ ) , M4
Parcel ID: Zoning Map # Parcel # District(s)
(TO BE FILLED IN BY THE BUILDING DEPARTMENT)
5. Existing Use of Structure /Property: 64 &I) t LIZ Orr( L L.
6. Description of Proposed Use/Work/Project /Occupation: (Use additional sheets if necessary)
7. Attached Plans: Sketch Plan Site Plan Engineered /Surveyed Plans
8. Has a Special PermitNariance /Finding ever been issued for /on the site?
NO DONT KNOW ` YES IF YES, date issued:
IF YES: Was the permit recorded at the Registry of Deeds?
NO DON'T KNOW YES
IF YES: Enter: Book Page and /or Document #
9. Does the site contain a brook, body of water or wetlands? NO DONT KNOW `> YES
IF YES: Has a permit been, or need to be, obtained from the Conservation Commission?
Needs to be obtained Obtained , Date issued
10. Do any signs exist on the property? YES v NO
IF YES: Describe the size, type and location: y X /0 I St 6A..)
Are there any proposed changes to, or additions of, signs intended for the property? YES L/ NO
1 '
IF YES: Describe the size, type and location: t . -L.0 ■ R O ` )
(A6 1 ov 6 f ) — S L"7 (zr+c)/L.
Page 2 of 3 $ L' 7 8AC v' "K 3 S 1 2T- 9 ,
City of Northampton
�/� .' < Massachusetts .. w : ',Ie
- t DEPARTI� NT OF BUILDING INSPECTIONS E
212 Main Street • Municipal Building '�;s ,b
Northampton, MA 01060 s� �
INSPECTOR Application for a Permit to Place or Maintain a Sign
Or Or other Advertising Device, or Marquee b A a 4 ��
( Application to be filled out in ink or typewritten) Number
Plans must be filed with the Building Inspector ` Erection ( )
before a permit will be granted. Alteration ( )
1►w" :- Repair ( )
Repainting ( )
i ,� 201 Removal ( )
oNNSpE s FEE PAGE PLOT
ofd\
Northampton, Mass. 20.....
To the Building Commissioner:
Application for a permit to place or maintain a sign or other advertising device, or marquee.
BUSINESS NAME o NC' -t- l)n -Cse -ti,,;
1. Location, Street and No. Imo' 4 5 sr‘ N30 -E , . cto 6a
2. Owner's name U"' C LP_ 61.---IT C4
3. Owner's address ? 1 - } , � Sr_ ) 0JL1 01 , AAA--
4. Maker's name --- POS/-c , :- ,• SWQ
5. Maker's address G CoAi Z s i - NS c tir j i
6. Erector's name ,.
7. Erector's address
SIGN KIND OF SIGN
(Designate)
1. Sign will be (check one) illuminated Non - illuminated
2. Will sign obstruct a fire escape, window or door? ...OP.. Marquee
3. Lower edge will be .. . ft ins above the public way. Projecting
4. Upper edge will be . JD. .ft ins above the public way. Roof
5. Height .....ft ins Width .1 ..ft ins Temporary
6. Face area ..''✓.? -sq. ft. Wall
7. Inner edge will be ^ ins from the building or pole. Ground v'
8. Outer edge will be - ins from the building or pole. Other
9. Face of building or pole is ) is back from the street line.
10. Sign will project ins beyond the street line.
11. Sign will extend — ft – ins above the building or pole.
12. Of what material will sjgn be c�istructed? Frame HL , J M '' - Face Ft.
13. Estimated cost $ 5,
The undersigned certifies that the above statements are true to the best of his knowledge and belief.
(Signature of Owner or Agent)
Page 1 of 3
File # BP- 2012 -0942
r ( `
��` r� Q � Y
APPLICANT /CONTACT PERSON PORCUPINE SIGNS t V \ ��
ADDRESS/PHONE 78 CONZ ST ( #REAR) NORTHAMPTON (413) 584 -4501 � 0- 't/
PROPERTY LOCATION 6 HATFIELD ST (P -A � ��
MAP 23B PARCEL 015 001 ZONE SI(100)/ CA C t
THIS SECTION FOR OFFICIAL USE ONLY: Q i Ac)
PERMIT APPLICATION CHECKLIST
ENCLOSED REQUIRED DATE
ZONING FORM FILLED OUT
Fee Paid
Building Permit Filled out Q
Fee Paid i
Typeof Construction: ERECT ILLUM GROUND SIGN - ONCALL URGENT CARE
New Construction
Non Structural interior renovations
Addition to Existing
Accessory Structure
Building Plans Included:
Owner/ Statement or License
3 sets of Plans / Plot Plan
THE FOLLOWING ACTION HAS BEEN TAKEN ON THIS APPLICATION BASED ON
INF9RMATION PRESENTED:
Approved Additional permits required (see below)
PLANNING BOARD PERMIT REQUIRED UNDER: §
Intermediate Project: Site Plan AND /OR Special Permit With Site Plan
Major Project: Site Plan AND /OR Special Permit With Site Plan
ZONING BOARD PERMIT REQUIRED UNDER: §
Finding Special Permit Variance*
Received & Recorded at Registry of Deeds Proof Enclosed
Other Permits Required:
Curb Cut from DPW Water Availability Sewer Availability
Septic Approval Board of Health Well Water Potability Board of Health
Permit from Conservation Commission Permit from CB Architecture Committee
Permit from Elm Street Commission Permit DPW Storm Water Management
Demolition Delay
5161/
Signature of Building Official Date
Note: Issuance of a Zoning permit does not relieve a applicant's burden to comply with all zoning
requirements and obtain all required permits from Board of Health, Conservation Commission, Department
of public works and other applicable permit granting authorities.
* Variances are granted only to those applicants who meet the strict standards of MGL 40A. Contact Office of
Planning & Development for more information.
City of Northampton Map 23B Lot0l5 Zone SI(100)/
Massachusetts Date issued 5/9/2012 0:00:00
Inspector of Buildings Permit # BP- 2012 -0942
Permit Fee$30.00
SIGN PERMIT
Business ONCALL URGENT CARE
Address 6 HATFIELD ST
Applicant InstallerPORCUPINE SIGNS
Applicant Installer Address 78 CONZ ST ( #REAR)
Work Description ERECT ILLUM GROUND SIGN - ONCALL URGENT
CARE
Estimated Cost $5000.00
Building Department
Approval by: